J Korean Ophthalmol Soc.  2013 Dec;54(12):1882-1887.

The Outcome of Graded Inferior Oblique Recession in the Congenital Unilateral Superior Oblique Palsy

• Moon SH
• Kim MM

Abstract

PURPOSE
To examine changes in vertical deviation and improvement in head tilt after graded inferior oblique (IO) recession surgery in patients with congenital unilateral superior oblique palsy (SOP). Frequency of inferior oblique overaction (IOOA) or bilateral SOP in the contralateral eye after surgery was also investigated.
METHODS
We retrospectively reviewed medical records of 65 patients who had undergone graded IO recession surgery in unilateral congenital SOP with at least 1 year of postoperative follow-up. Postoperative vertical deviation was classified as excellent (under 3 prism diopters, PD), good (4-7 PD) or poor (over 8 PD). The occurrence of IOOA was considered if more than 2 IOOAs were observed in the contralateral eye after surgery.
RESULTS
Forty-five of the 65 patients (69%) obtained excellent results and 67.3% had improvement in head tilt after surgery. IOOA in the contralateral eye was not observed in any patients before surgery. Postoperative IOOA in the contralateral eye occurred in 9 patients (13.8%) and a diagnosis of masked bilateral SOP was made in 1 patient (1.5%).
CONCLUSIONS
The graded IO recession procedures are considered to be an effective surgical method for the treatment of unilateral congenital SOP. However, IOOA or masked bilateral SOP occurring in the contralateral eye was observed in 15.3% of the patients undergoing surgery.

Keyword

Head tilt; Inferior oblique overaction; Inferior oblique recession surgery; Masked bilateral superior oblique palsy; Superior oblique palsy

MeSH Terms

Diagnosis
Follow-Up Studies
Head
Humans
Masks
Medical Records
Paralysis*
Retrospective Studies

Figure

• 

  Figure 1. Drawing of the various recession points in the right eye. A point is 4 mm posterior and 4.4 mm temporal to the lateral border of the inferior rectus muscle insertion (Fink’s point). B point is 3 mm posterior and 2 mm temporal (Scheie- Parks point). C point is position of the inferotemporal vortex vein. LR=lateral rectus muscle; MR=medial rectus muscle; IR=inferior rectus muscle.

Reference

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